kinase inhibitors, need to be examined in laboratory chemopreventive models to address this issue. The updated results of the NSABP P-1 trial conﬁrm the role of tamoxifen as a chemopreventive for women at high-risk of breast cancer. Although the beneﬁt of tamoxifen exceeds possible risks in patients with breast cancer, it remains unclear what degree of risk is appropriate for use of tamoxifen as a chemopreventive. New agents, with better side-eﬀect proﬁles, are in development as chemopreventives for oestrogen-receptor-positive breast cancer, and it is imperative that we identify agents that might decrease the incidence of oestrogen-receptornegative breast cancers. Despite the improved outcome from breast cancer, it remains certain that an ounce of prevention is better than a pound of cure.
Ruth M O’Regan Winship Cancer Institute, Emory University, Atlanta, GA30322, USA [email protected]
I declare that I have no conﬂict of interest. 1
Jordan VC. Eﬀect of tamoxifen (ICI 46,474) on initiation and growth of DMBA-induced rat mammary carcinomata. Eur J Cancer 1976; 12: 419–24.
Early Breast Cancer Trialists’ Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 1998; 351: 1451–67. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998; 90: 1371–88. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 2005; 97: 1652–62. Cuzick J, Forbes J, Edwards R, et al. First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial. Lancet 2002; 360: 817–24. Powles T, Eeles R, Ashley S, et al. Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial. Lancet 1998; 352: 98–101. Veronesi U, Maisonneuve P, Rotmensz N, et al. Italian randomized trial among women with hysterectomy: tamoxifen and hormone-dependent breast cancer in high-risk women. J Natl Cancer Inst 2003; 95: 160–65. Cuzick J, Powles T, Veronesi U, et al. Overview of the main outcomes in breast-cancer prevention trials. Lancet 2003; 361: 296–300. Martino S, Cauley JA, Barrett-Connor E, et al. Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene. J Natl Cancer Inst 2004; 96: 1751–61. Black LJ, Sato M, Rowley ER, et al. Raloxifene (LY139481 HCI) prevents bone loss and reduces serum cholesterol without causing uterine hypertrophy in ovariectomized rats. J Clin Invest 1994; 93: 63–69. Delmas PD, Bjarnason NH, Mitlak BH, et al. Eﬀects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med 1997; 337: 1641–47. Kudachadkar R, O’Regan RM. Aromatase inhibitors as adjuvant therapy for postmenopausal patients with early stage breast cancer. CA Cancer J Clin 2005; 55: 145–63.
You need hands The use of gestures is universal, but their meaning is culturally determined. To the older inhabitants of northern Greece and southern Sardinia, for example, a harmless thumbs-up may be more akin to le bras d’honneur than to some warm-hearted expression of approval. And even those gesturing within their own culture are not immune to error. Margaret Thatcher, when ﬁrst elected UK Prime Minister, was temporarily oblivious to the diﬀerence between the palm-forward and palm-backward versions of the humble V-sign. Anthropology has always taken a descriptive interest in gesture, and the importance of sign language in coping with deafness has prompted many studies. But more searching analyses have begun to probe the links between gestures, speech, and even learning. Some of the ﬁndings are as unexpected as they are intriguing. Psychologist Elena Nicoladis of Calgary, Canada has been studying the hand gestures that people make while speaking.1 One group was bilingual children whose task was to tell the same story in English and French. The researchers had assumed, reasonably, that the www.thelancet.com Vol 367 April 29, 2006
children would use more gestures when speaking the weaker of their two languages, relying on their hands to help them along. In fact, they moved their hands more when speaking the language in which they had greater proﬁciency. One of the leading ﬁgures in the gesture-research community is another psychologist, Susan GoldinMeadow, at the University of Chicago, Illinosis, USA. She has done several studies of the role of gesture in teaching and learning.2 It is well established that students learn better if teachers reinforce their words with relevant actions.3,4 What is less obvious is that the gestures can convey information additional to that carried by the spoken words. Goldwin-Meadow oﬀers the example of a teacher who describes water being poured into two cylindrical vessels of equal volume but diﬀerent height. The obvious accompanying gesture is to place one hand above the other, and alter their vertical separation to illustrate tall and short. But there are alternatives. One is to place the hands side by side, then move them apart when talking of the short cylinder, and bring them 1383
together when referring to the tall one. This mismatch between language and gesture serves to impart extra information: that the taller cylinder will be narrower, the shorter one wider. As Melissa Singer and Susan Goldin-Meadow have recently shown experimentally with a group of children being taught how to solve a simple mathematical problem, mismatches of this kind can be an aid to learning.5 These investigators asked teachers to stand in front of a blackboard and use words accompanied by gestures to describe a particular strategy for tackling the maths problem. Surprisingly, the best results were obtained when the teachers reinforced their words not with gestures illustrating the strategy being described, but with gestures hinting at an alternative strategy. Even less intuitively obvious is the value of imitating the hand movements of those doing the teaching. But in the same series of experiments Singer and Goldin-Meadow noticed that the best learners were the students who spontaneously adopted the teachers’ gestures, and used them when solving similar problems for themselves. 1384
To understand what might be going on here is not easy, but Goldin-Meadow and her collaborators have a further experiment6 that speaks to the question. It relies on individuals doing not one task but two. They ﬁrst have to solve a mathematical equation displayed on a blackboard, next try to memorise a list of words or letters, then explain how they went about solving the maths problem. Finally they are tested to ﬁnd out how many of the words they can still remember. It turns out that if you prevent individuals from gesturing—making add or multiply hand movements, for example—while they explain their mathematical method, they remember fewer words from the list. Goldin-Meadow4 argues that the act of gesturing somehow saves the speaker cognitive eﬀort that can then be used on other tasks—in this casememory. Speech and gesture—a “cognitive prop” is the term that she uses to describe its role—go together; indeed, she adds, the two probably evolved together. Other interpretations are, of course, possible; but her work does hint at a deep connection of some kind between speech and gestures. After all, even the congenitally blind gesture when speaking. When we use the word “gesture” we often do so dismissively—as in gesture politics and token gesture. The word has a poor image, which if the researchers are correct, belies the true importance of the thing it describes. Nor should we neglect the subversive quality of our hand movements. “The gestures we produce reﬂect our thoughts,” says Goldin-Meadow, “and those thoughts are often not revealed in our words.”7 So, watch those hands. Geoﬀ Watts 28 New End Square, London NW3 1LS, UK geoﬀ@scileg.freeserve.co.uk I declare that I have no conﬂict of interest. 1
2 3 4 5 6 7
Nicoladis E, Pika S, Marentette P. Gesturing bilingually: French-English bilingual children’s gestures. Presented at the 10th International Association for the Study of Children, Berlin, 2005. Perry M, Berch D, Singleton J. Constructing shared understanding: the role of non-verbal input in learning contexts. J Contemp Legal Issues 1995; 6: 213–35. Valenzeno L, Alibali MW, Klatzky R. Teachers’ gestures facilitate students’ learning: a lesson in symmetry. Contemp Educat Psychol 2003; 28: 187–204. Goldin-Meadow S. Hearing gesture: how our hands help us think. Cambridge: Harvard University Press, 2003. Singer MA, Goldin-Meadow S. Children learn when their teachers’ gestures and speech diﬀer. Psychol Sci 2005; 16: 85–89. Wagner S, Nusbaum H, Goldin-Meadow S. Probing the mental representation of gesture: is handwaving spatial? J Memory Lang 2004; 50: 395–407. Goldin-Meadow S. Press conference. Advance Science, Serving Society meeting. St Louis, MO, USA; Feb 16–19, 2006.
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